EAGLE GIFTS GALORE
2707 S. DESERT FOREST AVE., ONTARIO, CA 91761   Voice: (909) 947-6634
Fax: (909) 947-6666     e-Mail:  egg@EagleGiftsGalore.net     http://www.EagleGiftsGalore.net
BOY   SCOUT® THANK  YOU  POEM  PLAQUE
ORDER  FORM

If you are ordering a Boy Scout®Thank You Poem Plaque, use this form.
For Cub Scout
®Poem Plaques, please use the Cub Scout®™ Thank You Poem Plaque Order Form.
If you are ordering a poem for your Eagle Scout®son, please use the Eagle Scout® Poem Plaque Order Form
For Deluxe Poem Plaques, please use the Deluxe Poem Plaque Order Form.
For Photo Poem Plaques, please use the Photo Poem Plaque Order Form.

ORDER  FORM  INSTRUCTIONS
1.Enter your Background Paper choice.   (See Background Papers pages.)
2. Select Poem.  (See Poem Plaques page for poem choices & wording.)
3.Select Plaque color.*      7. Total your order.
4. Fill in Date plaque is needed by.      8. Fill in your contact information.
5.Enter your Troop # and Council Name.**      9. Fill in payment information.
6. Enter your Personal Message.    10. Print Form.

*Some background papers look better in Walnut, some in Black Marble.
If you prefer, we can choose the best plaque color for your background paper choice.
**This information will help us to determine if your leader has already received the poem you are ordering for him or her.
Use your browser's "Print" feature to print this form, sign it, and Fax or mail it to the address above.

Please do NOT send Credit Card information via eMail.


POEM INFORMATION
Background Paper:  
Select Poem:   Poem
Select plaque color:  
Date plaque is needed by:   - -
Troop Number:  
Council Name:  
Personal Message
Recipient's Name or Line 1
Sentiment or Line 2
Presentor's Name(s) & Date or Line 3

* * * * * * * * * * * * * * * * * * * * * * * *


ORDER   SUMMARY
  Poem Plaque   @  $ 31.95   =  $   31.95
  Black Marble-Look Plaque   @  $   5.00   =  $     5.00
  Shiping & Handling   @  $ 16.50   =  $   16.50
  California Sales Tax*   @     8 %     =   $  
      Total   =  $  
* California Residents only

Billing Address
  Name          
 Address 1    
 Address 2    
 City              
 State                   Zip    
 E-Mail    
    Main Phone Number
   Home       Mobile  
    - -
  Second Phone Number
   Mobile       Work  
    - -

Shipping Address (if different)
We must have a phone number for the shipping address.
  Name             Phone     - -
  Address 1       City    
  Address 2       State     Zip    

PAYMENT   INFORMATION:
 Check Enclosed
  Please charge my Credit Card
  Pay with PayPal

CREDIT  CARD   INFORMATION:
Name on Credit Card:
First NameMiddle InitialLast Name
Please make sure that the Billing Address (above) is where the credit card statement is sent.
  Credit Card Type:      Visa     Mastercard     Discover  
CREDIT   CARD   NUMBER: EXPIRATION   DATE: SECURITY   CODE:
    (on back of card)
                  
 
 
Signature: ______________________________________________________________________________________

BS PP   Rev. Feb. 2016